Nutritional Supplementation in Migraine Management
By James P. Meschino, DC, MSMany patients seek the help of chiropractors for the relief of migraine headaches, and several clinical trials, as well as anecdotal evidence, support the use of chiropractic manipulation as an intervention to reduce migraine headache frequency, duration, nausea and sensitivity to light.1-10 Acupuncture and percutaneous electrical nerve stimulation are other physical modalities that have been shown to benefit migraine sufferers.11-22 In recent years, a number of studies have shown that administration of certain nutritional supplements can further help reduce the frequency and severity of migraine attacks in susceptible individuals.
Magnesium is essential for energy production, protein synthesis, muscle contraction, nerve excitability and conduction, and as a cofactor in numerous enzyme systems (more than 300 enzymes). Magnesium and calcium tend to antagonize one another's effects on muscle contraction and depolarization. Calcium activates muscle contraction, whereas magnesium is a muscle relaxer. This effect on decreasing muscle cell excitability may be of importance in the treatment of acute-phase ischemic heart disease, fibromyalgia, asthma, migraine headaches and other problems. Magnesium is also important, along with calcium, sodium, potassium and phosphorous, in nerve activity and muscle contraction.
Studies have shown that migraine sufferers have lower blood and brain levels of magnesium.23-26 Several studies suggest that magnesium supplementation can reduce the frequency and severity of migraine episodes, presumably by calming the nerves and/or neuromuscular circuitry involved in the pathogenesis of these headaches. In a study involving primarily premenopausal women, supplementation with magnesium (average intake: 200 mg per day) reduced the frequency of migraines in 80 percent of those treated.27 In a double-blind study involving 81 migraine patients, daily dosage of 600 mg of magnesium significantly reduced migraine frequency compared to placebo.28 Premenstrual migraine attacks were reduced in another double-blind study using a daily dosage of 360 mg of magnesium supplementation.29 Intravenous administration of magnesium produced marked and sometimes complete symptom relief during acute migraine attack, usually within 15 minutes or less.
Migraine headaches have also been attributed to low serotonin levels or function in blood vessels. The precursor to the formation of serotonin is 5-hydroxytryptophan, which occurs naturally in the seed of an African plant known as Griffonia simplicifolia. Extraction of 5-hydroxytryptophan from the seed of this plant has made supplementation with naturally occurring 5-hydroxytryptophan available to the natural health products world. Studies on migraine sufferers have shown that supplementation with 5-hydroxytryptophan can raise serotonin levels and help in the global management of migraines.
In a 40-day study involving 40 migraine patients, daily supplementation with 200 mg of 5-hydroxytry-ptophan reduced the frequency of migraine headaches by 50 percent, a result similar to that reported by patients in the same study who were given methyserigide, a common drug used to control migraines.31-32 Two double-blind studies showed that daily supplementation with 600 mg of 5-hydroxytryptophan significantly reduced frequency of migraine headaches in known migraine sufferers.33-34 Other studies achieving good results with migraine sufferers used daily supplementation of 400 mg of 5-hydroxytryptophan.35-36 Some studies have shown that 5-hydroxytry-ptophan may also help with childhood migraine headaches at a daily intake level equal to 20 mg for every 10 pounds of body weight.37
It should be noted that the serotonin elevation induced by supplementation with 5-hydroxytryp-tophan may produce any of several side-effects, including drowsiness, gastrointestinal upset, headache, muscle pain or anxiety. This supplement should not be taken concurrently with antidepressant drugs or other mood-altering medications, as it may cause serotonin syndrome, which can be life-threatening.
Essential Oil Supplementation
Some studies have shown that supplementation with combinations of omega-3 fats (flaxseed oil or fish oil) and/or essential oils rich in gamma-linolenic acid (e.g., borage seed oil), a unique omega-6 fatty acid, can significantly reduce the severity, frequency and duration of migraine headaches. It is known that omega-3 fats from fish and flaxseed oil; and gamma-linolenic acid, from borage seed oil (also evening primrose and black currant oil) are converted into anti-inflammatory prostaglandin hormones in the body, which also help improve and regulate blood flow and platelet function. All of these physiological effects may account for the ability of essential fatty acid supplementation to help in the management of migraines.38-40
I suggest that patients choose an essential oil supplement that contains equal amounts of borage seed oil, flaxseed oil and fish oil (yielding 30 percent EPA and 20 percent DHA). Instructing migraine patients to take three to six capsules per day of this formulation (with each capsule containing 1,200 mg of essential oils) should help to favorably augment their prostaglandin synthesis, blood flow and platelet function.
Riboflavin (Vitamin B2)
For reasons that are difficult to understand, supplementation with high doses of the B vitamin riboflavin has been shown to benefit migraine sufferers, according to two well-controlled trials. In one study, supplementation with 400 mg per day of riboflavin reduced frequency and severity of migraine headaches by 66 percent in 49 migraine sufferers.41 In a follow-up double-blind trial of three months' duration, researchers reported that 59 percent of migraine sufferers assigned to receive high-dose riboflavin supplementation showed a 50 percent reduction in the number of headaches, compared with only 15 percent of those assigned the placebo product.42 Riboflavin plays a significant role in energy production, which may indirectly account for its effects in controlling migraines.
Feverfew is the most popular herb used over the years to control migraines. Three double-blind studies have reported that continuous use of feverfew leads to a reduction in the severity, duration and frequency of migraine headaches.43-46 Active ingredients in this herb have been shown to block the production of inflammatory prostaglandin hormones. These active ingredients also relax smooth muscle (e.g., in arteries and arterioles) and inhibit platelet aggregation. Any combination of these effects may account for the success that feverfew has shown in migraine control. When recommending feverfew, it is important to guide patients to a product that contains 0.2 percent parthenolide content. Two to three 250 mg capsules should be taken daily for preventive purposes.47-48 It may take several months before feverfew supplementation begins to work in controlling the frequency of migraine episodes, so encourage patients not to give up on this intervention if positive results are not seen in the first four weeks.
In addition to chiropractic adjustments, soft tissue work, acupuncture and percutaneous electrical nerve stimulation, holistic practitioners should be aware of the adjunctive role that nutritional supplementation can play in the global and natural management of migraine headaches. Based upon the available evidence, it may be wise to include the following supplementation strategy in the management of migraine patients:
Vitamin D is routinely measured in ug/L (micrograms per liter), which is also the same as ng/mL (nanograms per milliliter), and in nmol/L (nanomoles per liter). In my previous two-part article, "Why Your Patients Need More Vitamin D After Age 45," blood levels of vitamin D (25-hydroxycholecalciferol) were incorrectly submitted in ng/mL instead of nmol/L throughout the article. The numeric values presented in the article are correct, but the units must be changed to nmol/L to reflect accuracy. Otherwise, the numeric values for blood levels of vitamin D listed throughout the article must be multiplied by .361 to reflect their accurate values in ng/mL. The author apologizes for any confusion this may have caused.
James Meschino, DC, MS
Toronto, Ontario Canada
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